The incidence of pyoderma gangrenosum is estimated to be three to 10 cases per million people per year. It is often associated with systemic disease such as inflammatory bowel disease, arthropathies, and hematologic diseases. The pathogenesis is thought to be related to neutrophil dysfunction with a component related to abnormal immune system response. Treatment is dependent on the severity of the disease. Local pyoderma gangrenosum is treated with a barrier cream and wound care to try to prevent infection. Topical steroids can also be used. If the disease is more severe, systemic corticosteroid therapy should be considered. If this does not seem to be helping, cyclosporine should be considered. Systemic steroids can result in improvement in as little as one week. It is also important to address underlying systemic disease that may be contributing to the condition.
Explore This IssueACEP Now: Vol 37 – No 11 – November 2018
This patient was discharged on prednisone 50 mg twice a day, with a plan to taper over several weeks. It was also recommended that the patient use Vaseline with Xeroform and Kerlix for dressing changes. Cyclosporine could not be considered for this patient as he had renal disease. The patient was discharged from the hospital and was told to follow up closely with dermatology. The patient did not show up for his follow-up visits and was lost to follow-up.
Dr. Vento is an emergency medicine resident at MetroHealth in Cleveland.
Dr. Roehrs and Dr. Effron are emergency physicians at MetroHealth.
Resources for Further Reading
- Ahronowitz I, Harp J, Shinkai K. Etiology and management of pyoderma gangrenosum: a comprehensive review. Am J Clin Dermatol. 2012;13(3):191-211.
- Chow RK, Ho VC. Treatment of pyoderma gangrenosum. J Am Acad Dermatol. 1996;34(6):1047-1060.
- Ruocco E, Sangiuliano S, Gravina AG, et al. Pyoderma gangrenosum: an updated review. J Eur Acad Dermatol Venereol. 2009;23(9):1008-1017.